摘要
目的系统评价单孔胸腔镜与传统三孔腔镜手术治疗自发性气胸的疗效。方法计算机检索PubMed、EMbase、The Cochrane Library、CBM、CNKI、WanFang Data数据库,搜集单孔胸腔镜与三孔胸腔镜手术比较治疗自发性气胸的随机对照试验和队列研究,检索时限均为建库至2014年12月。由2位研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入8个研究,均为队列研究,共483例患者。Meta分析结果显示:与传统三孔腔镜手术相比,单孔胸腔镜手术治疗自发性气胸手术时间更短[MD=–3.90,95%CI(–7.22,–0.58),P=0.02],术中出血量更少[MD=–9.34,95%CI(–15.26,–3.42),P=0.002],胸腔引流时间更短[MD=–0.66,95%CI(–1.02,–0.29),P=0.000 4],术后24 h疼痛VAS评分更低[MD=–0.90,95%CI(–1.14,–0.66),P<0.000 01],术后皮肤感觉异常发生率更低[OR=0.15,95%CI(0.07,0.31),P<0.000 01]。两组在平均住院时间[MD=–0.30,95%CI(–0.63,0.03),P=0.08]和术后气胸复发率[OR=0.68,95%CI(0.25,1.83),P=0.44]方面,差异无统计学意义。结论与传统三孔腔镜手术相比,单孔胸腔镜手术治疗自发性气胸时具有一定的优势。受纳入研究数量和质量限制,上述结论尚需开展更多大样本、高质量的研究予以验证。
Objective To systematically evaluate the effectiveness and safety of single-incision video-assisted thoracic surgery（VATS） versus conventional three-port VATS for primary spontaneous pneumothorax. Methods We searched databases including PubMed, EMbase, The Cochrane Library, CBM, CNKI and WanFang Data from inception to Dec.2014, to collect randomized controlled trials（RCTs） and cohort studies comparing single-incision VATS and conventional three-port VATS for primary spontaneous pneumothorax. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, RevMan 5.3 software was used for meta-analysis. Results A total of 8 cohort studies involving 483 patients were finally included. The results of meta-analysis showed that： Compared with conventional three-port VATS, single-incision VATS had shorter operation time（MD= –3.90, 95%CI –7.22 to –0.58,P=0.02）, less amount of intraoperative bleeding（MD= –9.34, 95%CI –15.26 to –3.42, P=0.002）, shorter chest drainage time（MD= –0.66, 95%CI –1.02 to –0.29, P=0.000 4）, lower VAS score of 24h-postoperative pain（MD= –0.90, 95%CI–1.14 to –0.66, P〈0.000 01） and lower incidence of postoperative paresthesia（OR=0.15, 95% CI 0.07 to 0.31, P〈0.000 01）.Meanwhile, there were no statistical differences between both groups in hospital stay（MD= –0.30, 95%CI –0.63 to 0.03,P=0.08） and the recurrence of pneumothorax（OR=0.68, 95%CI 0.25 to 1.83, P=0.53）. Conclusion Current evidence shows, single-incision VATS is superior to conventional three-port VATS in the treatment of spontaneous pneumothorax.However, due to limited quality and quantity of included studies, more large-scale, high-quality studies are needed to verify the above conclusion.
出处
《中国循证医学杂志》
CSCD
2015年第8期945-950,共6页
Chinese Journal of Evidence-based Medicine
关键词
单孔胸腔镜
三孔胸腔镜
自发性气胸
系统评价
META分析
队列研究
Single-incision video-assisted thoracic surgery
Three-port video-assisted thoracic surgery
Spontaneous pneumothorax
Systematic review
Meta-analysis
Cohort Study
